Patients are considered eligible for allied health services if their GP has completed the following prerequisite Chronic Disease Management items:

a GP management plan (GPMP) - item 721, and

team care arrangements (TCAs) - item 723

If your patient is a permanent resident of a Residential Aged Care facility (RACF), their GP must have contributed to a multidisciplinary care plan prepared for them by the RACF or to a review of the care plan (item 731). Hospital in-patients are not eligible.

The GP determines the number and combination of services that are appropriate for the patient’s treatment requirements. Only the GP can determine whether the patient’s chronic condition would benefit from allied health services. It is not appropriate for allied health professionals to provide a part-completed referral form to a GP for signing, or to pre-empt the GPs decision about the services required by the patient.

If there is any doubt about a patient’s eligibility, you can call us to confirm the number of allied health services already claimed by the patient during the calendar year.

Claiming frequency

Eligible patients have a limit of 5 services per calendar year. The 5 services may be made up of:

1 type of service, for example 5 physiotherapy services, or

a combination of different types of services, for example 1 dietetic and 4 podiatry services

Referral requirements

A separate referral form is needed for each service type. The referral is valid for the number of services outlined in the referral. Medicare benefits are not payable for services provided in excess of the number specified in the referral.

The referral form should be retained for 24 months.

Reporting requirements

A written report must be provided back to the referring GP after the first and last service, or more often if clinically necessary.

Written reports should include any investigations, tests, and/or assessments carried out on the patient, any treatment provided and future management of the patient’s condition or problem.